What works for whom in the management of diabetes in people living with dementia: a realist review

Background Dementia and diabetes mellitus are common long-term conditions and co-exist in a large number of older people. People living with dementia (PLWD) may be less able to manage their diabetes, putting them at increased risk of complications such as hypoglycaemia. The aim of this review was to identify key mechanisms within different interventions that are likely to improve diabetes outcomes in PLWD. Methods This is a realist review involving scoping of the literature and stakeholder interviews to develop theoretical explanations of how interventions might work, systematic searches of the evidence to test and develop the theories and their validation with a purposive sample of stakeholders. Twenty-six stakeholders — user/patient representatives, dementia care providers, clinicians specialising in diabetes or dementia and researchers — took part in interviews, and 24 participated in a consensus conference. Results We included 89 papers. Ten focused on PLWD and diabetes, and the remainder related to people with either dementia, diabetes or other long-term conditions. We identified six context-mechanism-outcome configurations which provide an explanatory account of how interventions might work to improve the management of diabetes in PLWD. This includes embedding positive attitudes towards PLWD, person-centred approaches to care planning, developing skills to provide tailored and flexible care, regular contact, family engagement and usability of assistive devices. An overarching contingency emerged concerning the synergy between an intervention strategy, the dementia trajectory and social and environmental factors, especially family involvement. Conclusions Evidence highlighted the need for personalised care, continuity and family-centred approaches, although there was limited evidence that this happens routinely. This review suggests there is a need for a flexible service model that prioritises quality of life, independence and patient and carer priorities. Future research on the management of diabetes in older people with complex health needs, including those with dementia, needs to look at how organisational structures and workforce development can be better aligned to their needs. Trial registration PROSPERO, CRD42015020625. Registered on 18 May 2015

Exploiting computerized adaptive testing for self-directed learning

Self-directed learning enables learners to take responsibility for and to design their own learning-related activities. Frequent assessments facilitate self-directed learners to monitor learning regularly. Often, quizzes with multiple-choice (MC), true-false, or fill-in-the-gap items are a quick way of gathering information on the strengths and weakness of learners. Although with limitations, such kinds of items can assess both low-level (e.g., fact recall and comprehension) and high-level (e.g., application, analysis, and evaluation) thinking and are particularly suitable for online computerized testing, largely because they can be scored by computers. This chapter starts with an introduction to traditional paper-and-pencil testing, followed by computer-based testing, and six commonly used test delivery models. Then, key features, underlying measurement theory, major steps, and constructions of computerized adaptive testing, are described. This chapter ends with some concluding remarks and discussion of future developments of CAT

Introduction to the Water Splitting Reaction

This chapter will cover the most important aspects concerning the water splitting reaction by providing an overall description of the main solutions, as reported in the literature, addressing the improvement of the efficiency of solar driven hydrogen production. The natural water splitting system will be considered as a starting point, in order to gain a better understanding of the main challenges that material scientists are facing towards the development of novel catalysts of water oxidation, mainly. The attention will focus on the water oxidation half-reaction, since it is the most complex and demanding process from both the kinetic and thermodynamic points of view. In addition, some general aspects of the photocatalytic water splitting and the principal semiconductors studied for such process will be reviewed